BUFFALO, New York (Reuters) – Laicie Manzella lived in a rundown house on Buffalo’s east side when three of her children tested with dangerously high levels of lead in their blood. Her oldest son suffered nosebleeds, body rashes and a developmental disorder requiring speech therapy.

Checking her apartment, county health inspectors found 15 lead violations, all linked to old paint in this blue collar city plagued by lead poisoning.

A Reuters investigation found at least four city zip codes here where 40 percent of children tested from 2006 to 2014 had high lead levels, making Buffalo among the most dangerous lead hotspots in America. The rate of high lead tests in these areas was far worse – eight times greater – than that found among children across Flint, Michigan, during that city’s recent water crisis.

Federal support has helped Manzella and other families in Buffalo and beyond. This month, her family moved into a gleaming, lead-free apartment renovated by a local nonprofit with funding from the U.S. Department of Housing and Urban Development.

This type of assistance may not last much longer. President Donald Trump is advocating deep federal budget cuts that would sap billions from programs used by state and local governments to protect children from the lifelong health impacts of lead exposure.

“If they go and snatch these funds away, where are we going to get help from?” Manzella said.

It’s a question being asked in cities across the United States bracing for cuts in programs that identify and eradicate lead poisoning hazards. Awareness of lead poisoning escalated following Flint’s crisis, and more recently from Reuters reporting that has identified more than 3,300 areas with childhood lead poisoning rates at least double those found in the Michigan city.

Some of the areas slated to be hit hardest supported Trump in November’s election, though he lost Erie County, where Buffalo is the county seat.

At least eight of the nine federal agencies sharing responsibility for lead poisoning prevention face potential budget cuts. But the heaviest lifting falls to HUD, the Centers for Disease Control and Prevention, and the Environmental Protection Agency. Trump’s budget would cut at least $4.7 billion from programs at HUD and the EPA that support healthy housing and lead pollution cleanup efforts, a Reuters analysis found. Funding for a CDC program that assists states with poisoningprevention is uncertain.

Cuts would be felt across the country. The Trump administration would eliminate a $27 million program that trains private contractors on lead removal, and a $21 million program that funds leadabatement projects in Alaska, Illinois, Ohio, Oklahoma and California. It would kill a program that provided funds to a Rhode Island nonprofit to upgrade housing, and end a $970 million affordable-housing program that has fixed up dilapidated homes in hundreds of U.S. cities, including Flint.

If the cuts clear Congress, some experts fear the fight against lead could stall out for years.

Instead of saving money, the cost of inaction could spiral, Burstein said. More children would be afflicted by learning disabilities and other neurological problems, leaving localities to foot the bill for treatment programs.

White House officials declined to comment.

Decades of lead abatement have sharply curbed childhood lead levels across the United States. But studies have shown no level of lead in the blood is safe, and poisoning persists in thousands of locales.

PINPOINTING HOTSPOTS

In December, Reuters used previously undisclosed data obtained from 21 states to pinpoint nearly 3,000 U.S. neighborhoods where poisoning rates among tested children were at least twice as high as in Flint.

Reporters have since obtained testing results covering eight additional states and expanded data from two more, including New York, Louisiana, New Jersey, Virginia, New Hampshire and California. The new data reveal another 449 neighborhoods with rates that high.

The communities stretch from affluent neighborhoods in the Los Angeles area to an impoverished quarter of Shreveport, Louisiana, to a rural town in Salem County, New Jersey, where Trump won 56 percent of the vote in November.

The data paints a partial picture. Reuters has not obtained neighborhood-level testing results for 21 states and the District of Columbia. These areas cited privacy concerns or said they do not have the data.

Still, the available results show the toxic metal remains a threat to millions of children.

Federal programs fund testing for children, cleanup of industrial lead hazards and poisoning-awareness efforts. Other programs require inspections or abatement in housing built before 1978, when lead was banned from residential paint.

The few planned funding increases under Trump may not be as beneficial as they appear. HUD’s Healthy Homes and Lead Hazard Control Program is slated to receive a $20 million boost, but the agency has proposed eliminating $4.1 billion worth of grant programs local officials say play a bigger role in reducing risks.

“I think you’re going to see more children, not fewer children, exposed to lead,” said Senator Jack Reed, a Democrat who has sought more funding for lead-abatement programs on the Senate subcommittee that funds HUD.

Congress, which controls federal spending, may not go along. A spokeswoman for Senator Susan Collins described lead-based hazards as “one of the most prevalent health issues facing children today.” She said the Maine Republican would use her position as head of the subcommittee that controls HUD’s budget to oppose cuts.

BUFFALO A HOTBED FOR LEAD

Buffalo has long fought a legacy of lead contamination. Blood data shows 17 city zip codes where the rate of tested children with high lead levels was at least double that of Flint – about 8,000 children over nine years.

“Nobody’s talking about Buffalo as ground zero for the lead problem, but when it comes to the levels of lead that’s been identified in children, it’s higher than what you see in Flint,” said Erie County Executive Mark Poloncarz.

Buffalo’s problem stems from a simple equation: Old houses plus high poverty equal lead poisoning. Older homes are often blanketed with lead paint, and the water pipes and fixtures typically contain lead. In poorer neighborhoods, homes are frequently neglected, leading to exposure from peeling paint or dust. Fifty-eight percent of the city’s housing was built before 1940; nearly 40 percent of residents live below the poverty line.

Still, Buffalo and Erie County have made progress. In 2007, three city zip codes had 50 percent of tested children with high lead levels. By 2014, the prevalence in those zip codes dropped to an improved, but still worrisome, 30 percent.

Progress came thanks to millions of dollars in federal assistance flowing to local programs.

From 2012 through 2016, Buffalo was granted $27.7 million from the now-threatened HUD HOME Investment and Partnerships Program. HUD’s blessing brought far greater resources to bear, with city, county and nonprofits using the grant to attract another $200 million to revitalize or replace 1,125 housing units, making them all lead-safe.

Among those helped: The Chowdhurys, a family of five who moved to the east side of Buffalo in 2010, settling in a neighborhood with one of the highest lead poisoning rates in the country.

Within two months, their one-year-old daughter, Nabiha, was found to have a lead level about twice that of the elevated threshold set by the CDC, five micrograms per deciliter. Any child at or above CDC’s threshold warrants a public health response, the agency says.

MD Chowdhury, a restaurant waiter, and his wife, Nazneen Fatema, didn’t know how their daughter was poisoned or how to help her, but Buffalo and Erie County did.

Local officials dispatched housing inspectors, nurses and contractors to identify and repair thelead hazards in the family’s home. Replacing the lead-paint coated windows and siding and installing a new roof cost about $40,000. Federal grant programs footed the bill.

Erie County’s Health Department receives $244,000 a year from the CDC to help fund five full-time employees and three part-time employees who refer at-risk children for testing, investigate the causes of lead poisoning and conduct educational home visits. Those staffers helped the family.

Chowdhury also took EPA-funded classes on how to safely remove lead-based-paint so he could do additional work himself.

Two years ago, the couple had another daughter. She has never tested high.

“Without these programs, it’s hard to know about lead, and my income is not enough to do all of the work we needed,” Chowdhury said.

Trump’s budget proposal would kill much of the funding that helped the family through its ordeal.

Buffalo Mayor Byron Brown said the case illustrates the larger peril of potential funding cuts. “There would be people who would fall through the cracks,” he said.

CARSON’S MIXED MESSAGE

While working as a pediatric neurosurgeon in Baltimore, Dr. Benjamin Carson saw the irreversible damage lead can cause in the brains of children living in substandard housing.

At his confirmation hearing in February to serve as Trump’s secretary of HUD, Carson told the Senate Banking Committee he would be “vigorous” in his efforts to reduce the tally of hundreds of thousands of poisoned children across the country.

“I’m looking forward to, you know, the Safe and Healthy Homes Program at HUD and enhancing that program very significantly,” Carson said.

But even Carson’s requested $20 million increase for HUD’s lead removal program falls short of the $29 million his agency says is needed to comply with a new policy that requires lead remediation of HUD properties where children have tested above the CDC threshold.

Other housing programs that play a bigger, if more indirect, role in protecting children’s health would be eliminated altogether.

Among them: the $125 million Choice Neighborhoods program, which provided funding to removelead paint from New Orleans’ aging Iberville housing project, and the $970 million HOME Partnerships program, which helped the Chowdhurys clean up their house in Buffalo.

The biggest casualty could be HUD’s $3 billion Community Development Block Grant program.

Local officials use CDBG grants to fund projects from curb construction to rehabilitating old housing, with only a small portion, $10 million, directly used for lead safety standards in the most recent fiscal year.

But CDGB is crucial to poisoning prevention, since housing-related projects it helps are required to meet HUD guidelines for lead safety, said Marion McFadden, who oversaw HUD’s grant programs under President Barack Obama.

“If (cuts are) enacted, it would be a huge step backward,” McFadden said.

CDBG funds went toward lead-paint removal in cities including Milwaukee, Syracuse and Shreveport, Louisiana. All three had neighborhoods with documented lead poisoning rates at least twice Flint’s.

BUDGET CUTS IN AMISH COUNTRY

Health officials in the small city of York, Pennsylvania, two hours west of Philadelphia in Amish country, know how budget cuts like this can play out.

The city and surrounding York County, where Trump won 70 percent of the vote in November, have a serious lead poisoning problem. From 2005 through 2014, at least 30 percent of children tested in all but one of York’s census tracts had elevated lead exposure, according to CDC data. In one census tract, more than half of all tested children had high lead levels.

Trump lost the city of York, but other patches of the county hit hard by lead poisoning, including the borough of Red Lion, where 21 percent of children tested had high levels, overwhelmingly supported him.

In the mid 1990s, York had seven full-time and part-time employees working in the city’s lead prevention program who conducted screening and investigated lead exposure sources. Since then, CDC cuts have left the program with one part-time employee and no ability to conduct screening.

The results are telling. In 2005, 1,641 city children were screened for lead. In 2014, 169 kids received a lead test.

Trump’s plan to eliminate the $375,000 in Home Partnership funds the city uses to develop lead-safe housing would have dire consequences, said James Crosby, deputy director of the city’s Bureau of Housing Services.

“It would mean we would be out of business,” Crosby said. “If he eliminates the home program, we would have absolutely nothing.”

A HUD spokesman declined to comment on the impact the cuts would have. “HUD will continue to work very closely with state and local health and housing officials through targeted investments in specific programs to reduce childhood lead poisoning,” he said.

CUTS AT THE EPA

A similar pattern is emerging at the EPA, where Administrator Scott Pruitt is highlighting somelead remediation efforts while pushing to gut funding to enforce pollution laws and clean up contaminated sites.

During the confirmation process, Pruitt told lawmakers he would work to reduce exposure to lead. On Wednesday he visited East Chicago, Indiana, where the EPA has secured $42 million from chemical companies to remove contaminated soil from neighborhoods near a former lead-smelting plant. In one neighborhood, up to 20 percent of tested children had elevated lead-blood levels.

Trump’s budget proposal would preserve funding for the EPA program that helps cities like Flint buy new water pipes.

But Pruitt would slash other federal efforts, including a one-third cut of EPA’s Superfund and Brownfield programs, leaving hundreds of millions of dollars less to clean up areas contaminated by lead mining in southeast Missouri, tainted yards and parks in Omaha and old school buildings on the Standing Rock Sioux reservation in North Dakota.

Pruitt would also eliminate a $27 million program that trains private contractors on safe lead removal from buildings, internal documents show.

An EPA spokesman said the agency is weighing strategies to save taxpayers money while protecting the environment. “We’re trying to restore some accountability to these and other programs so that we can examine what has worked – and most especially, what hasn’t,” wrote spokesman J.P. Freire.

Funding levels for the CDC, which spent $17 million last year through the Childhood Lead Poisoning Prevention program to help state and local governments, have been the subject of great uncertainty.

Earlier this year Trump lobbied for a Republican health-care bill that would have repealed the Affordable Care Act. In the process, the bill would have eliminated the pool of public-health money that funds the CDC’s lead program. In March, the bill collapsed in the House of Representatives.

Last week, a White House official told Reuters the administration intends to keep funds flowing to the CDC program. By Monday, however, the official had backed away from that commitment and said the program’s fate is uncertain until the administration produces a more detailed budget proposal in May.

The last round of cuts to the CDC’s lead budget in 2011 slashed assistance to many state poisoning prevention programs.

Those cuts were a reason why Flint’s problems didn’t come to light sooner, said Mary Jean Brown, a public health specialist at Harvard University who directed CDC’s lead program at the time. Without the CDC lead program, Michigan conducted less monitoring of childhood blood levels from 2011 to 2014, and stopped reporting test results to the CDC.

This created “a big gap in data,” Brown said, contributing to Flint’s crisis going unchecked or being ignored by Michigan officials until a pediatrician, scientists and activists presented proof children had been sickened.

(Editing by Ronnie Greene)

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